Comparison of ceftriaxone with penicillin for antibiotic prophylaxis for compound mandible fractures
Heit J M, Stevens M R, Jeffords K
Record Status
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.
Health technology
Ceftriaxone and penicillin for antibiotic prophylaxis for compound mandible fracture.
Type of intervention
Secondary prevention.
Economic study type
Cost-effectiveness analysis.
Study population
Male and female patients with compound mandible fractures.
Setting
Hospital. The economic study was carried out in Miami, Florida, USA.
Dates to which data relate
Not reported.
Source of effectiveness data
Effectiveness data were derived from a single study.
Link between effectiveness and cost data
The costing was undertaken prospectively on the same patient sample as that used in the effectiveness study.
Study sample
Power calculations were not used to determine the sample size. The study sample consisted of 90 patients with compound mandible fractures. The patient population comprised 76 (84.4%) male participants and 14 (15.6%) female participants. Patients ranged in age from 10 to 63 years, with a mean age of 29.6 years. The patients were randomly assigned to one of two groups: Group 1 received an intravenous administration of 1 gm ceftriaxone daily before surgery, and Group 2 received an intravenous administration of 2 million U Pen G before surgery.
Study design
This was a randomised controlled trial, carried out in a single centre. The duration of the follow-up was 8 weeks. No loss to follow-up was reported. Examiners, blinded to the patient's protocol, monitored patients at 2-week intervals for 8 weeks.
Analysis of effectiveness
The principle (intention to treat or treatment completers only) used in the analysis of effectiveness was not explicitly specified. The primary health outcomes used in the analysis were the estimates of the complications after either perioperative drug regimen.
Effectiveness results
Two patients in each group were estimated to have postoperative infections within 2 weeks.
Clinical conclusions
The preoperative dose of 1 gm ceftriaxone showed no statistical difference in infection rate or difference in systemic side effects in comparison with penicillin. No additional hospitalization or laboratory studies were required.
Measure of benefits used in the economic analysis
The benefit measure was estimates of the complications after either perioperative drug regimen.
Direct costs
Discounting was not undertaken due to the short period of follow-up. Quantities were not fully analysed separately from costs. The costs of the two treatment regimens (dosage price plus the cost of intravenous administration) were included in the study. The quantity/cost boundary adopted was the patient. The date of the price data was not stated. The cost of professional staff time was not included in the cost analysis.
Indirect Costs
Not considered.
Currency
US dollars ($).
Sensitivity analysis
No sensitivity analysis was undertaken.
Estimated benefits used in the economic analysis
Two patients in each group were estimated to have postoperative infections within 2 weeks.
Cost results
The total daily cost of rocephin antibiotic was estimated to be $87.21 versus $219.06 for penicillin. The cost difference between the two treatment regimens was approximately $350 per day of therapy.
Synthesis of costs and benefits
Costs and benefits were not combined since the use of the intervention was a weakly dominant strategy (with the same efficacy and less costs compared to the comparator).
Authors' conclusions
Ceftriaxone was noted to be an efficacious and cost-effective treatment alternative to penicillin G for compound mandible fracture antibiotic prophylaxis.
CRD COMMENTARY - Selection of comparators
A justification was given for the choice of the comparator. It was regarded as an effective antibiotic therapy in the context in question. You, as a database user, should consider whether this is a widely used health technology in your own setting.
Validity of estimate of measure of benefit
The estimate of measure of benefit used in the economic analysis is likely to be internally valid given the use of a randomized study design.
Validity of estimate of costs
Quantities were not fully analysed separately from costs and insufficient details of the methods of quantity/cost estimation were provided.
Other issues
The issue of generalisability to other settings was not addressed. Insufficient information was given regarding the dates of the data collection and the fiscal year adopted in the analysis.
Source of funding
None stated.
Bibliographic details
Heit J M, Stevens M R, Jeffords K. Comparison of ceftriaxone with penicillin for antibiotic prophylaxis for compound mandible fractures. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics 1997; 83(4): 423-426